Abstract
ObjectiveThe purpose of our study was to evaluate the effectiveness of thermal ablation (TA) for Bethesda IV thyroid nodules, and to compare TA and surgery in terms of treatment outcomes, complications, and costs.MethodThis study was approved by the local ethics committee. From January 2017 to December 2019, 30 patients elected TA and 31 patients elected surgery for treatment of Bethesda IV thyroid nodules. Demographics information and conventional ultrasound before treatment for each patient was obtained. For the TA group, the ablation extent was 3 mm beyond the edge of the tumor to prevent marginal residual and recurrence. Patients were followed up at 1, 3, and 6 months after intervention, and every 6 months thereafter. Postoperative complications, operation time, hospitalization time, blood loss, and incision length were recorded.ResultsIn the TA group, the volume reduction ratio (VRR) was 94.63 ± 8.99% (range:76%-100%) at the final follow-up. The mean follow-up time was 16.4 ± 5.2months (range:12–24 months). No recurrences, no metastatic lymph node, and no distant metastases were detected during follow-up. The TA group had fewer complications, shorter operation time, smaller incision length, less blood loss, shorter hospitalization time, and lower treatment costs compared to the surgery group (all P<0.001).ConclusionsTA is technically feasible for the complete destruction of Bethesda IV thyroid nodules, and also safe and effective during the follow-up period, with high VRR and low complication rates, especially in patients who were ineligible for or refused surgery.
Highlights
Thyroid nodule has become increasingly common in clinical practice
We reviewed the medical records of 61 patients who were diagnosed as Bethesda IV thyroid nodules by fine-needle aspiration (FNA) in our department from January 2017 to December 2019, including patients of ultrasound-guided TA treatment and patients of surgical treatment (Figure 1)
For the TA group, patients who fulfilled the following criteria were enrolled: [1] a solitary suspicious thyroid nodule was detected by ultrasound; [2] located in the thyroid gland and with no thyroid capsule contact; [3] no imaging evidence of extrathyroidal invasion, lymph node metastasis, or distant metastasis; [4] ultrasound-guided FNA confirming Bethesda IV cytology; [5] refusal of or ineligibility for surgery due to medical contraindications or other reasons; and [6] complete records and more than 12 months of follow-up
Summary
Thyroid nodule has become increasingly common in clinical practice This trend possibly stems from the improved detection of asymptomatic and incidental thyroid nodules due to the application of high-resolution ultrasound or other imaging. The indeterminate result creates a management difficulty, and the American Thyroid Association’s guidelines recommend diagnostic lobectomy and molecular testing for the management of follicular neoplasm cytology nodules [2]. Lobectomy is the definitive diagnosis tool to distinguish malignant tumors from adenoma, which is based on the presence of vascular or capsular invasion; molecular testing may be used to supplement risk assessment [4]. With the increased incidence of Bethesda IV thyroid nodules, an increased number of elderly patients, and the fact that most of such nodules are often benign, more patients are either high surgical risk and ineligible to undergo surgery or unable to afford the high cost of molecular testing; they may refuse surgery, hoping for other more conservative treatments
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